Newly emerging areas for the PIE framework

Over time, and in the course of multiple discussions, a number of new areas have emerged, since the original formulation of the PIE, and its evolution into the ‘classic’ account.

User involvement and access to therapy

Peter Cockersell – one of the authors of the 2012 guidance – has argued in discussions, and in a recently published paper, that that guidance had omitted to mention two crucial areas, the first being a commitment to user involvement; and the second the role of PIEs in enabling access to more formal psychotherapy. These, he suggests, need to be included in any revised framework.

To what extent user involvement can be read as one of the primary themes for a PIE is open to dispute. Others such as Dick Laban have argued that the majority of clients we see are in what we now call, following Prokashka and Diclemente, the pre-contemplative stage, and we need to identify and promote effective ways to work with them that do not require introspection or any wish for personal change. Jay Levy's work on Pretreatment shows how far we may have to go, to find a common lanhuage that even allows the possibiity of such change.

Although there may be many ways to engage precontempative clients in the PIE, explicit user involvement structures and opportunities will clearly not be the only way. To reconcile these two apparently opposed points, we might want to conclude that all three issues need to be included; but that none of them is definitive of a PIE. All three, that is, are significant aspects, but are better treated as examples in practice of some wider theme.

This means that this issue has to feature in any revised formulation, although any particular practice in a particular setting might be best seen as one of the optional expressions, rather than one of the definitive themes.

The ‘green’ (or ‘grown’) and the surrounding environment

Whilst the term ‘built environment’ suggests architecture, and to a lesser extent furnishings and other designed features of a building, there is an overlap between what is entirely man-made, and what is grown – whether that means houseplants, plants in a garden, or a greenhouse, or a farm.

Similarly there are animals that may be involved, from fish in a tank or a cat or parrot to horses – all which are especially used in some forms of therapy. There is a fairly seamless connection between a PIE in a hostel or other ‘built’ environment and the wider uses of a relationship with nature and growing things, in what is now known as eco-therapy’.

(There are also similar difficulties in clarifying and establish an evidence base for the overall effectiveness, or for the ‘active ingredient’ in such environmental interventions, which suggests that a collaboration over research might be productive.)

There are also other environments – like a park, or a car – that are indeed designed, but not for the explicit purpose of the service, and are not owned or managed by the services (as the original account of a PIE had explicitly assumed a PIE would be). Nevertheless, they may be consciously used as part of the offer of the service. In other fields this is called re-purposing, but in this case, it is perhaps more a case of adding a new and more inclusive meaning to an existing general purpose or public use.

This suggests a possible widening or extension of the concept of the built environment as a creator of ‘social spaces’, to include other aspects which might in fact be designed. This, in turn, allows for a clearer boundary between this kind of ‘physical environment” and the social environment created by the service itself – which we will discuss further under the heading on “Managing relationships” in the next section.

A PIE of pathways

This is about the environment of other services (or lack of them) around a service, that particular services will be taking into account, insofar as these are significant for the meaning and the role of the service in the life and trajectory of the client. They are part of the ‘psychological meaning’ for the individual, that the service must be aware of and work effectively with.

Johnson has argued - elsewhere on this site - that these service network contexts of the work are just as significant – for the user as well as the provider – as the work carried out within any one service. In outreach work, or in relatively short-term services, the routes into and out from the service are ever-present realities.

Senior managers will be giving some thought to the boundaries of the service, and how services fit together, complement each other, or leave gaps. Local commissioners in particular may be responsible for creating what would, in an ideal world, be a fairly seamless and coherent network of services and routes into and exiting from a services.

How might we refer to and include this aspect of the work – the wider context as well as the immediate setting of a day service, a shelter?

Other developments in parallel

Meanwhile, the discovery of creative work in homelessness was not unique to the UK; but in other countries such as the US and Canada, or France, it arose in different contexts, and took other forms. Most notably, we see the development of Housing First and Trauma Informed Care, in the US; and pre-treatment, also originating in the US.

As the PIEs idea began to spread, the issues arise as to how (and where?) to align this other new thinking with the PIEs framework. The immediate solution seemed to be to simply create new areas on the PIElink to discuss such developments and there to compare them, in discussion, with the PIE concept.

NB: In a first draft of an extensive paper, posted here, Johnson explored the similarities and differences between these international developments and philosophies. The final version is still in preparation, although an excerpt, shaped to appear as a chapter in a forthcoming book, is now available, and published as the monthly essay for February (see: Housing First; addressing the community dimension).